Does Imperial Preferred Gold cover levothyroxine?
Imperial Preferred Gold
98113-98113UT0020002-0 · ACA · ACA Marketplace
levothyroxine
levothyroxineunder Imperial Preferred Gold
Covered — the conditions depend on which form
Not the same for every form: 42 of 113 need your plan’s approval first, and 48 of 113 usually need a preferred medication tried first. Check your exact form in the list below — your doctor’s office handles either.
What you'd pay
$5per 30-day fill
From the first fill — no deductible on this drug.
This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.
Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
- Tier
- Generic
- Approval first
- Required
- Try another first
- Required
- Amount limit
- Yes
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.
Covered forms and strengths (113)
- levothyroxine sodium 0.013 MG Oral CapsuleApproval first
- levothyroxine sodium 0.013 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.013 MG/ML Oral Solution [Tirosint]Approval first
- levothyroxine sodium 0.02 MG/ML Oral Solution [Thyquidity]Try another firstAmount limit
- levothyroxine sodium 0.025 MG Oral CapsuleApproval first
- levothyroxine sodium 0.025 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.025 MG Oral Tablet
- levothyroxine sodium 0.025 MG Oral Tablet [Euthyrox]
- levothyroxine sodium 0.025 MG Oral Tablet [Levo-T]Try another first
- levothyroxine sodium 0.025 MG Oral Tablet [Levoxyl]Try another first
- levothyroxine sodium 0.025 MG Oral Tablet [Synthroid]Try another first
- levothyroxine sodium 0.025 MG Oral Tablet [Unithroid]Try another first
- levothyroxine sodium 0.025 MG/ML Oral Solution [Tirosint]Approval first
- levothyroxine sodium 0.0375 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.0375 MG/ML Oral Solution [Tirosint]Approval first
- levothyroxine sodium 0.044 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.044 MG/ML Oral Solution [Tirosint]Approval first
- levothyroxine sodium 0.05 MG Oral CapsuleApproval first
- levothyroxine sodium 0.05 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.05 MG Oral Tablet
- levothyroxine sodium 0.05 MG Oral Tablet [Euthyrox]
- levothyroxine sodium 0.05 MG Oral Tablet [Levo-T]Try another first
- levothyroxine sodium 0.05 MG Oral Tablet [Levoxyl]Try another first
- levothyroxine sodium 0.05 MG Oral Tablet [Synthroid]Try another first
- levothyroxine sodium 0.05 MG Oral Tablet [Unithroid]Try another first
- levothyroxine sodium 0.05 MG/ML Oral Solution [Tirosint]Approval first
- levothyroxine sodium 0.0625 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.0625 MG/ML Oral Solution [Tirosint]Approval first
- levothyroxine sodium 0.075 MG Oral CapsuleApproval first
- levothyroxine sodium 0.075 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.075 MG Oral Tablet
- levothyroxine sodium 0.075 MG Oral Tablet [Euthyrox]
- levothyroxine sodium 0.075 MG Oral Tablet [Levo-T]Try another first
- levothyroxine sodium 0.075 MG Oral Tablet [Levoxyl]Try another first
- levothyroxine sodium 0.075 MG Oral Tablet [Synthroid]Try another first
- levothyroxine sodium 0.075 MG Oral Tablet [Unithroid]Try another first
- levothyroxine sodium 0.075 MG/ML Oral Solution [Tirosint]Approval first
- levothyroxine sodium 0.088 MG Oral CapsuleApproval first
- levothyroxine sodium 0.088 MG Oral Capsule [Tirosint]Approval first
- levothyroxine sodium 0.088 MG Oral Tablet